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. 2018 Mar 1;103(3):1214-1223.
doi: 10.1210/jc.2017-02426.

Causes, Patterns, and Severity of Androgen Excess in 1205 Consecutively Recruited Women

Yasir S Elhassan  1   2 , Jan Idkowiak  1   2 , Karen Smith  3 , Miriam Asia  2 , Helena Gleeson  2 , Rachel Webster  3 , Wiebke Arlt  1   2 , Michael W O'Reilly  1   2
Affiliations

Causes, Patterns, and Severity of Androgen Excess in 1205 Consecutively Recruited Women

Yasir S Elhassan et al. J Clin Endocrinol Metab. .

Abstract

Context: Androgen excess in women is predominantly due to underlying polycystic ovary syndrome (PCOS). However, there is a lack of clarity regarding patterns and severity of androgen excess that should be considered predictive of non-PCOS pathology.

Objective: We examined the diagnostic utility of simultaneous measurement of serum dehydroepiandrosterone sulfate (DHEAS), androstenedione (A4), and testosterone (T) to delineate biochemical signatures and cutoffs predictive of non-PCOS disorders in women with androgen excess.

Design: Retrospective review of all women undergoing serum androgen measurement at a large tertiary referral center between 2012 and 2016. Serum A4 and T were measured by tandem mass spectrometry and DHEAS by immunoassay. Patients with at least one increased serum androgen underwent phenotyping by clinical notes review.

Results: In 1205 women, DHEAS, A4, and T were measured simultaneously. PCOS was the most common diagnosis in premenopausal (89%) and postmenopausal women (29%). A4 was increased in all adrenocortical carcinoma (ACC) cases (n = 15) and T in all ovarian hyperthecosis (OHT) cases (n = 7); all but one case of congenital adrenal hyperplasia (CAH; n = 18) were identified by increased levels of A4 and/or T. In premenopausal women, CAH was a prevalent cause of severe A4 (59%) and T (43%) excess; severe DHEAS excess was predominantly due to PCOS (80%). In postmenopausal women, all cases of severe DHEAS and A4 excess were caused by ACC and severe T excess equally by ACC and OHT.

Conclusions: Pattern and severity of androgen excess are important predictors of non-PCOS pathology and may be used to guide further investigations as appropriate.

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Conflict of interest statement

The authors have nothing to disclose.

Figures

Figure 1.
Figure 1.
Flow chart of distribution of diagnoses according to premenopausal vs postmenopausal status in 1205 women who underwent simultaneous measurement of DHEAS, A4, and T. OvTu, ovarian tumor.
Figure 2.
Figure 2.
Distribution of androgen excess patterns in (A) all premenopausal women, (B) premenopausal women with underlying PCOS, (C) all postmenopausal women, and (D) postmenopausal women with underlying PCOS. +, increased; −, not increased.
Figure 3.
Figure 3.
Distribution of androgen excess patterns in (A) ACC, (B) CAH, and (C) OHT. +, increased; −, not increased; black bars, postmenopausal; white bars, premenopausal women.
Figure 4.
Figure 4.
Severity of androgen excess according to diagnosis and androgen measured. Three levels of androgen excess [mild (M), intermediate (I), and severe (S)] were arbitrarily defined for each androgen (for cutoffs, see Table 1) and are demarcated by dotted lines. Median values for each diagnosis are denoted by a solid black line.
See this image and copyright information in PMC

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